, Simo, Ricard1
, Nixon, Iain1
, Tikka, Theofano1
, Jeannon, Jean-Pierre1
, Ngu, Rose1
, Chandra, Ash1
, Moonim, Muffadal1
, Carroll, Paul1
, Tharavaj, Selvam1
1 Head and Neck and Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
Ultrasound-guided fine needle aspiration (USS-FNAC) is now the gold standard tool for evaluating patients with thyroid nodules with a false-negative rate of < 3%. However, the utility of USS-FNAC in the evaluation of Intrathoracic Goitres (ITGs) remains controversial.
To determine the value of USS-FNAC in the evaluation of ITG, to determine the incidence of cancer in ITG and establish the clinical implications of this diagnosis.
A review of 237consecutive patients undergoing surgery for ITG from 2004 to 2016 was undertaken. All patients were evaluated with USS-FNAC and cytology results of Thy3 or above were discussed in the thyroid multidisciplinary oncology meeting before surgery. Data on cytological and histological analysis was collected prospectively and analyzed.
Nineteen patients were diagnosed with thyroid cancer. The rate of malignancy in ITG is 8.01%. Twelve patients had benign pre-operative benign cytology results and resulting in a rate of unexpected occult malignancy of 0.46%. 18 patients had Papillary Thyroid Cancer and 1 patient Medullary Thyroid Cancer. Of the 13 patients undergoing initial hemithyroidectomy, 7 underwent completion surgery due to multicentricity or tumour stage. The USS-FNAC had a sensitivity of 33% and specificity 93.3% to exclude cancer.
Discussion & Conclusion:
Surgery for ITG is challenging. It requires accurate evaluation and a multidisciplinary approach by specialised teams. USS-FNAC has poor sensitivity (33%) but high specificity (93.3%) to exclude cancer in ITGs. Patients undergoing initial hemi-thyroidectomy and diagnosed of cancer may need to undergo completion thyroidectomy due to the stage of tumour.